Healthcare Provider Details

I. General information

NPI: 1821181314
Provider Name (Legal Business Name): CHARLOTTE HUMPHRIES LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRAL STATE HOSPITAL - RED RIVER TREATMENT CENTER UNIT 6, MEADOW LANE
PINEVILLE LA
71360
US

IV. Provider business mailing address

108 VALLEY DRIVE
PINEVILLE LA
71360
US

V. Phone/Fax

Practice location:
  • Phone: 318-484-6402
  • Fax: 318-487-5703
Mailing address:
  • Phone: 318-640-4304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number750494
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: